Remote monitoring system for ambulatory patients

ABSTRACT

The monitoring device incorporates a memory device that is programmed with a set of question hierearchies. Each question hierarchy corresponds to a symptom and is composed of a set of questions. The question hierarchies may contain a logical structure so that certain questions will not be asked, depending upon a patient&#39;s answer to a preceeding question. A question hiearchy is invoked by a symptom identifier transmitted to the monitoring device by a remote computer. The remote computer may transmit a plurality of symptom identifiers to the monitoring device to cause the monitoring device to ask questions related to a plurality of symptoms. The set of symptoms inquired about may vary based upon the chronic disease afflicting the patient.

RELATED APPLICATIONS

This application is a continuation-in-part of U.S. application Ser. No.09/949,197 filed on Sep. 7, 2001, entitled “APPARATUS AND METHOD FORTWO-WAY COMMUNICATION IN A DEVICE FOR MONITORING AND COMMUNICATINGWELLNESS PARAMETERS OF AMBULATORY PATIENTS,” which is acontinuation-in-part of U.S. application Ser. No. 09/293,619 filed onApr. 16, 1999 (which issued Sep. 18, 2001 as U.S. Pat. No. 6,290,646)entitled “APPARATUS AND METHOD FOR MONITORING AND COMMUNICATING WELLNESSPARAMETERS OF AMBULATORY PATIENTS,” both of which are herebyincorporated by reference in its entirety.

BACKGROUND

There is a need in the medical profession for an apparatus and methodcapable of monitoring and transmitting physiological and wellnessparameters of ambulatory patients to a remote site where a medicalprofessional caregiver evaluates such physiological and wellnessparameters. Specifically, there is a need for an interactive apparatusthat is coupled to a remote computer such that a medical professionalcaregiver can supervise and provide medical treatment to remotelylocated ambulatory patients.

There is needed an apparatus that monitors and transmits physiologicaland wellness parameters of ambulatory patients to a remote computer,whereby a medical professional caregiver evaluates the information andprovokes better overall health care and treatment for the patient.Accordingly, such an apparatus can be used to prevent unnecessaryhospitalizations of such ambulatory patients.

Also, there is needed an apparatus for monitoring and transmitting suchphysiological and wellness parameters that is easy to use and that isintegrated into a single unit. For example, there is a need for anambulatory patient monitoring apparatus that comprises: a transducingdevice for providing electronic signals representative of measuredphysiological parameters, such as weight; an input/output device; and acommunication device as a single integrated unit that offers ambulatorypatients ease of use, convenience and portability.

Patients suffering from chronic diseases, such as chronic heart failure,will benefit from such home monitoring apparatus. These patientsnormally undergo drug therapy and lifestyle changes to manage theirmedical condition. In these patients, the medical professional caregivermonitors certain wellness parameters and symptoms including: weakness,fatigue, weight gain, edema, dyspnea (difficulty breathing or shortnessof breath), nocturnal cough, orthopnea (inability to lie flat in bedbecause of shortness of breath), and paroxysmal nocturnal dyspnea(awakening short of breath relieved by sitting or standing); and bodyweight to measure the response of drug therapy. Patients will alsobenefit from daily reminders to take medications (improving compliance),reduce sodium intake and perform some type of exercise. With theinformation received from the monitoring device, the medicalprofessional caregiver can determine the effectiveness of the drugtherapy, the patient's condition, whether the patient's condition isimproving or whether the patient requires hospitalization or an officeconsultation to prevent the condition from getting worse.

Accordingly, there is needed an apparatus and method for monitoring thepatients from a remote location, thus allowing medical professionalcaregivers to receive feedback of the patient's condition without havingto wait until the patient's next office visit. In addition, there isneeded an apparatus and method that allows medical professionalcaregivers to monitor and manage the patient's condition to prevent therehospitalization of such patient, or prevent the patient's conditionfrom deteriorating to the point where hospitalization would be required.As such, there are social as well as economic benefits to such anapparatus and method.

The patient receives the benefits of improved health when theprofessional caregiver is able to monitor and quickly react to anyadverse medical conditions of the patient or to any improper responsesto medication. Also, society benefits because hospital resources willnot be utilized unnecessarily.

As a group, patients suffering from chronic heart failure are the mostcostly to treat. There are approximately 5 million patients in theU.S.A. and 15 million worldwide with chronic heart failure. Themortality rate of patients over 65 years of age is 50%. Of those thatseek help and are hospitalized, 50% are rehospitalized within 6 months.Of these, 16% will be rehospitalized twice. The patients that arehospitalized spend an average of 9.1 days in the hospital at a cost of$12,000.00 for the period. Accordingly, there is a need to reduce therehospitalization rate of chronic heart failure patients by providingimproved in-home patient monitoring, such as frequently monitoring thepatient's body weight and adjusting the drug therapy accordingly.

Approximately 60 million American adults ages 20 through 74 areoverweight. Obesity is a known risk factor for heart disease, high bloodpressure, diabetes, gallbladder disease, arthritis, breathing problems,and some forms of cancer such as breast and colon cancer. Americansspend $33 billion dollars annually on weight-reduction products andservices, including diet foods, products and programs.

There is a need in the weight management profession for an apparatus andmethod capable of monitoring and transmitting physiological and wellnessparameters of overweight/obese patients to a remote site where a weightmanagement professional or nutritionist evaluates such physiological andwellness parameters. Specifically, there is a need for an interactiveapparatus that is coupled to a remote computer such that a weightmanagement professional or nutritionist can supervise and providenutritional guidance to remotely located individuals.

The apparatus allows overweight individuals to participate in a weightloss/management program with accurate weight monitoring from home. Theapparatus improves the convenience for the individual participant byeliminating the need to constantly commute to the weight managementcenter and “weigh-in.” Furthermore, the individual can participate in aweight management program while under professional supervision from theprivacy and comfort of their own home. Moreover, the apparatus allowsthe weight management professional to intervene and adapt theindividuals diet and exercise routine based on the weight and wellnessinformation received.

For the foregoing reasons, there is a need for an apparatus, system andmethod capable of monitoring and transmitting physiological and wellnessparameters of ambulatory patients, such as body weight, to a remotelocation where a medical professional caregiver, weight managementprofessional or nutritionist can evaluate and respond to the patient'smedical wellness condition.

SUMMARY

Against this backdrop the present invention was created. A health caredevice for monitoring a health condition of an ambulatory patient mayinclude a display for presenting questions to the patient. Additonally,it may include an input device permitting the patient to enter answersto the questions. Further, it may include a microprocessor operablycoupled to the display and the input device. A read-only memory devicemay be operably coupled to the microprocessor. The read-only memorydevice may store a plurality of question hierarchies, with eachhierarchy of questions corresponding to each of a plurality of symptoms.A communication device may be operably coupled to the microprocessor.The microprocessor may be programmed to receive a symptom identifier viathe communication device. Based upon the symptom identifier, it may beprogrammed to ask a first question from the hierarchy of questionscorresponding to the symptom identified by the symptom identifier. Itmay also be programmed to receive an answer to the first question viathe input device. Finally, it may be programmed to make a decisionregarding whether to ask a subsequent question from the hierarchy, basedupon the answer to the first question.

According to another embodiment of the invention, a method formonitoring a health condition of an ambulatory patient may includereceiving a symptom identifier. Thereafter, a question is retrieved froma hierarchy of questions stored in a read-only memory device. Thehierarchy corresponds to a symptom identified by the symptom identifier.The retrieved question is asked to the patient. Next, an answer to thequestion is received from the patient. Thereafter, a decision regardingwhether to ask a subsequent question from the hierarchy is made, basedupon the answer to the question. The memory device stores a plurality ofquestion hierarchies, with each hierarchy of questions corresponding toeach of a plurality symptoms.

According to yet another embodiment of the invention, a method formonitoring a health condition of an ambulatory patient may includetransmitting a symptom identifier to a health care device containing aread-only memory that stores a plurality of question hierarchies. Eachhierarchy of questions corresponds to each of a plurality of symptoms.The transmission causes the health care device to ask to the patient oneor more questions from a hierarchy corresponding to the symptomidentified by the symptom identifier.

According to yet another embodiment of the invention, a method ofanalyzing a set of answers to questions drawn from a plurality ofquestion hierarchies may include assigning a point value to eachquestion within each hierarchy. The point value may be earned if thequestion to which it is assigned is answered in accordance with apre-defined answer. A total point value, which is a sum of the pointvalues assigned to each question that was asked, may be determined.Additionally, an earned point value, which is a sum of all pointsearned, may be determined. Then, a ratio between the earned point valueand the total point value may be determined. Finally, a health careprovider may be notified if the ratio exceeds a threshold.

According to yet another embodiment of the invention, a method ofanalyzing a set of answers to questions drawn from a plurality ofquestion hierarchies may include assigning a point value to eachquestion within each hierarchy. The point value may be earned if thequestion to which it is assigned is answered in accordance with apre-defined answer. A threshold value is assigned to each hierarchy ofquestions. Also, the number of points earned in each question hierarchyis determined, based upon the answers. Finally, a health care providermay be notified, if more than a pre-defined number of points are earnedwithin more than a pre-defined number of question hierarchies.

According to yet another embodiment of the invention, a health caresystem for monitoring a health condition of an ambulatory patient mayinclude a health care device and a central computer system. The healthcare device may include a display for presenting questions to thepatient. It may also include an input device permitting the patient toenter answers to the questions. A microprocessor may be operably coupledto the display and the input device. A read-only memory device may beoperably coupled to the microprocessor. The read-only memory device maystore a plurality of question hierarchies, with each hierarchy ofquestions corresponding to each of a plurality of symptoms. Acommunication device may be operably coupled to the microprocessor. Themicroprocessor may be programmed to receive a symptom identifier via thecommunication device. Based upon the symptom identifier, themicroprocessor may ask a first question from the hierarchy of questionscorresponding to the symptom identified by the symptom identifier. Ananswer to the first question may be reveived via the input device. Basedupon the answer to the first question, a decision regarding whether toask a subsequent question from the hierarchy may be made. The centralcomputer system may be in communication with the microprocessor of thehealth care device. The central computer system may be programmed totransmit the symptom identifier to the microprocessor, thereby causingthe microprocessor to ask one or more questions within the hierarchiescorresponding to the symptom identified by the symptom identifier. Apoint value may be assigned to each question within each hierarchy.Based upon the assigned point values, it may be determine whether thepatient is in need of care.

BRIEF DESCRIPTION OF THE DRAWINGS

These and other features, aspects and advantages of the invention willbecome better understood with regard to the following description,appended claims and accompanying drawings where:

FIGS. 1A-E illustrates several embodiments of the monitoring apparatusin accordance with the invention;

FIG. 2 illustrates a monitoring apparatus with a support member inaccordance with one embodiment of the invention;

FIG. 3 illustrates a monitoring apparatus with a support member inaccordance with one embodiment of the invention;

FIG. 4 is a functional block diagram of a microprocessor system formingan environment in which one embodiment of the invention may be employed;

FIG. 5 is functional block diagram of a microprocessor system formingthe environment in which one embodiment of the invention may beemployed;

FIG. 6 is a functional block diagram of a microprocessor system formingthe environment in which one embodiment of the invention may beemployed;

FIG. 7 illustrates a system in which one embodiment of the invention maybe employed;

FIG. 8 is a logic flow diagram illustrating the steps utilized toimplement one embodiment of the invention;

FIG. 9 illustrates a sectional view of the electronic scale inaccordance with one embodiment of the invention; and

FIG. 10 illustrates a top plate of the electronic scale in accordancewith one embodiment of the invention.

FIG. 11 illustrates a high-level depiction of a monitoring systemutilizing two-way communication, in accordance with one embodiment ofthe present invention.

FIG. 12 depicts a flow of operation that permits two-way communicationbetween a central computer and a monitoring apparatus.

FIG. 13 depicts another flow of operation that permits two-waycommunication between a central computer and a monitoring apparatus.

FIG. 14 depicts yet another flow of operation that permits two-waycommunication between a central computer and a monitoring apparatus.

FIG. 15 depicts a flow of operation that permits real-time two-waycommunication between a central computer and a monitoring apparatus.

FIG. 16 depicts a scheme of asking customized questions and collectingthe answers thereto.

FIG. 17 illustrates a graphical user interface that may be used inconjunction with software running on a central computer for the purposeof scheduling questions to be uploaded each day to a monitoringapparatus for questioning of a patient.

FIG. 18 illustrates a graphical user interface that may be used inconjunction with software running on a central computer for presenting aset of trending data.

FIG. 19 depicts a collapsible scale with carpet-spike pads, inaccordance with one embodiment of the invention.

FIG. 20 depicts an embodiment of the present invention, in which aphysiological parameter-measuring device is an optional component.

FIG. 21 depicts depicts an embodiment of a system, in which aphysiological parameter-measuring device is an optional component.

FIG. 22 depicts a memory device programmed with a set of questionhierarchies.

FIG. 23 depicts a particular question hierarchy logical structure,according to one embodiment of the present invention.

FIG. 24 depicts another question hierarchy logical structure, accordingto one embodiment of the present invention.

FIG. 25 depicts another question hierarchy logical structure, accordingto one embodiment of the present invention.

FIG. 26 depicts yet another question hierarchy logical structure,according to one embodiment of the present invention.

FIG. 27 depicts one method of determining whether a patient is in needof medical assistance, based upon the patient's response to questionspresented from a question hierarchy.

FIG. 28 depicts another method of determining whether a patient is inneed of medical assistance, based upon the patient's response toquestions presented from a question hierarchy.

DESCRIPTION

The embodiments of the invention described herein are implemented as amedical apparatus, system and method capable of monitoring wellnessparameters and physiological data of ambulatory patients andtransmitting such parameters and data to a remote location. At theremote location a medical professional caregiver monitors the patient'scondition and provides medical treatment as may be necessary.

The monitoring device incorporates transducing devices for convertingthe desired measured parameters into electrical signals capable of beingprocessed by a local computer or microprocessor system. The deviceinteracts with the ambulatory patient and then, via an electroniccommunication device such as a modem, transmits the measured parametersto a computer located at a remote site. At the remote location thevarious indicia of the ambulatory patient's condition are monitored andanalyzed by the medical professional caregiver. To provide theambulatory patient with an added level of convenience and ease of use,such monitoring device is contained in a single integrated package.Communication is established between the monitoring apparatus and aremote computer via modem and other electronic communication devicesthat are generally well known commercially available products. At theremote location, the caregiver reviews the patient's condition based onthe information communicated (e.g. wellness parameters and physiologicaldata) and provokes medical treatment in accordance with suchinformation.

Referring now to FIG. 1A, as this embodiment of the invention isdescribed herein, an integrated monitoring apparatus is shown generallyat 10. The integrated monitoring apparatus 10 includes an electronicscale 18. The electronic scale 18 further includes a top plate 11 and abase plate 12. The integrated monitoring apparatus 10 further includes ahousing 14 and a support member 16A. The base plate 12 is connected tothe housing 14 through the support member 16A. The housing 14 furtherincludes output device(s) 30 and input device(s) 28. The apparatus 10 isintegrated as a single unit with the support member coupling the baseplate 12 and the housing 14, thus providing a unit in a one piececonstruction.

It will be appreciated that other physiological transducing devices canbe utilized in addition to the electronic scale 18. For example, bloodpressure measurement apparatus and electrocardiogram (EKG) measurementapparatus can be utilized with the integrated monitoring apparatus 10for recordation and/or transmission of blood pressure and EKGmeasurements to a remote location. It will be appreciated that othermonitoring devices of physiological body functions that provide ananalog or digital electronic output may be utilized with the monitoringapparatus 10.

Referring to FIGS. 1B, 1C, 1D and 1E it will be appreciated that thesupport member 16A (FIG. 1A) can be made adjustable. For example, FIG.1B illustrates an embodiment of the invention utilizing a telescopingsupport member 16B. Likewise, FIG. 1C illustrates an embodiment of theinvention utilizing a folding articulated support member 16C. FIG. 1Dillustrates yet another embodiment of the invention utilizing supportmember 16D that folds at a pivot point 25 located at its base. It willalso be appreciated that other types of articulated and folding supportmembers may be utilized in other embodiments of the invention. Forexample, FIG. 1E illustrates an embodiment of the invention providing asupport member 16E that is removably insertable into a socket 23. Acable 22 is passed through the support member 16E to carry electricalsignals from the electronic scale 18 to the housing 14 for furtherprocessing. A tether 20 is provided to restrain the movement of thesupport member 16E relative to the base plate 12 once the it is removedfrom the socket 23.

FIG. 2 illustrates an embodiment of the invention where the supportmember 82 folds about pivot point 84. Folding the integrated monitoringapparatus about pivot point 84 provides a convenient method of shipping,transporting or moving the apparatus in a substantially horizontalorientation. The preferred direction of folding is indicated in thefigure, however, the support member 82 can be made to fold in eitherdirection. Furthermore, an embodiment of the invention provides rubberfeet 85 underneath the base plate 12.

Furthermore, FIG. 3 illustrates one embodiment of the inventionproviding an articulated, folding support member 86. The support member86 folds at two hinged pivot points 88, 90. Also illustrated is asectional view of the scale 18, top plate 11, base plate 12, load cell100 and strain gage 102.

Referring now to FIG. 4, a microprocessor system 24 including a CPU 38,a memory 40, an optional input/output (I/O) controller 42 and a buscontroller 44 is illustrated. It will be appreciated that themicroprocessor system 24 is available in a wide variety ofconfigurations and is based on CPU chips such as the Intel, Motorola orMicrochip PIC family of microprocessors or microcontrollers.

It will be appreciated by those skilled in the art that the monitoringapparatus requires an electrical power source 19 to operate. As such,the monitoring apparatus may be powered by: ordinary household A/C linepower, DC batteries or rechargeable batteries. Power source 19 provideselectrical power to the housing for operating the electronic devices. Apower source for operating the electronic scale 18 is generated withinthe housing, however those skilled in the art will recognize that aseparate power supply may be provided or the power source 19 may beadapted to provide the proper voltage or current for operating theelectronic scale 18.

The housing 14 includes a microprocessor system 24, an electronicreceiver/transmitter communication device such as a modem 36, an inputdevice 28 and an output device 30. The modem 36 is operatively coupledto the microprocessor system 24 via the electronic bus 46, and to aremote computer 32 via a communication network 34 and modem 35. Thecommunication network 34 being any communication network such as thetelephone network, wide area network or Internet. It will be appreciatedthat the modem 36 is a generally well known commercially availableproduct available in a variety of configurations operating at a varietyof BAUD rates. In one embodiment of the invention the modem 36 isasynchronous, operates at 2400 BAUD and is readily availableoff-the-shelf from companies such as Rockwell or Silicon Systems Inc.(SSI).

It will be appreciated that output device(s) 30 may be interfaced withthe microprocessor system 24. These output devices 30 include a visualelectronic display device 31 and/or a synthetic speech device 33.Electronic display devices 31 are well known in the art and areavailable in a variety of technologies such as vacuum fluorescent,liquid crystal or Light Emitting Diode (LED). The patient readsalphanumeric data as it scrolls on the electronic display device 31.Output devices 30 include a synthetic speech output device 33 such as aChipcorder manufactured by ISD (part No. 4003). Still, other outputdevices 30 include pacemaker data input devices, drug infusion pumps ortransformer coupled transmitters.

It will be appreciated that input device(s) 28 may be interfaced withthe microprocessor system 24. In one embodiment of the invention anelectronic keypad 29 is provided for the patient to enter responses intothe monitoring apparatus. Patient data entered through the electronickeypad 29 may be scrolled on the electronic display 31 or played back onthe synthetic speech device 33.

The microprocessor system 24 is operatively coupled to the modem 36, theinput device(s) 28 and the output device(s) 30. The electronic scale 18is operatively coupled to the central system 24. Electronic measurementsignals from the electronic scale 18 are processed by the A/D converter15. This digitized representation of the measured signal is theninterfaced to the CPU 38 via the electronic bus 46 and the buscontroller 44. In one embodiment of the invention, the physiologicaltransducing device includes the electronic scale 18. The electronicscale 18 is generally well known and commercially available. Theelectronic scale 18 may include one or more of the following elements:load cells, pressure transducers, linear variable differentialtransformers (LVDTs), capacitance coupled sensors, strain gages andsemiconductor strain gages. These devices convert the patient's weightinto a useable electronic signal that is representative of the patient'sweight.

In will be appreciated that Analog-to-Digital (A/D) converters are alsogenerally well known and commercially available in a variety ofconfigurations. Furthermore, an A/D converter 15 may be included withinthe physiological transducing device or within the microprocessor system24 or within the housing 14. One skilled in the art would have a varietyof design choices in interfacing a transducing device comprising anelectronic sensor or transducer with the microprocessor system 24.

The scale 18 may provide an analog or digital electronic signal outputdepending on the particular type chosen. If the electronic scale 18provides an analog output signal in response to a weight input, theanalog signal is converted to a digital signal via the A/D converter 15.The digital signal is then interfaced with the electronic bus 46 and theCPU 38. If the electronic scale 18 provides a digital output signal inresponse to a weight input, the digital signal may be interfaced withelectronic bus 46 and the CPU 38.

FIG. 5 illustrates one embodiment of the invention where thecommunication device is a radio frequency (RF) transceiver. Thetransceiver comprises a first radio frequency device 50 including anantenna 52, and a second radio frequency device 54, including an antenna56. The first radio frequency device 52 is operatively coupled to themicroprocessor system 24 via the electronic bus 46, and is in radiocommunication with the second radio frequency device 54. The secondradio frequency device 54 is operatively coupled through amicroprocessor 55 which is operatively coupled to a modem 58. The modem58 is coupled to the communication network 34 and is in communicationwith the remote computer 32 via the modem 35. The first radio frequencydevice 50 and the second radio frequency device 54 are remotely located,one from the other. It will be appreciated that such radio frequencydevices 50, 54 are generally well known and are commercially availableproducts from RF Monolithics Inc. (RFM).

In one embodiment of the invention, such transceivers operate at radiofrequencies in the range of 900-2400 MHz. Information from themicroprocessor system 24 is encoded and modulated by the first RF device50 for subsequent transmission to the second RF device 54, locatedremotely therefrom. The second RF device 54 is coupled to a conventionalmodem 58 via the microprocessor 55. The modem 58 is coupled to thecommunication network 34 via a in-house wiring connection and ultimatelyto the modem 35 coupled to the remote computer 32. Accordingly,information may be transmitted to and from the microprocessor system 24via the RF devices 50, 54 via a radio wave or radio frequency link, thusproviding added portability and flexibility to the monitoring apparatus10. It will be appreciated that various other communications devices maybe utilized such as RS-232 serial communication connections, Internetcommunications connection as well as satellite communicationconnections. Other communications devices that operate by transmittingand receiving infra-red (IR) energy can be utilized to provide awireless communication link between the patient monitoring apparatus 10and a conveniently located network connection. Furthermore, X-10™ typedevices can also be used as part of a communication link between thepatient monitoring apparatus 10 and a convenient network connection inthe home. X-10 USA and other companies manufacture a variety of devicesthat transmit/receive data without the need for any special wiring. Thedevices works by sending signals through the home's regular electricalwires using what is called power line carrier (PLC).

Referring now to FIG. 6, one embodiment of the invention wherein adigital electronic scale 21 is provided. Digital weight measurementsfrom the digital electronic scale 21 may be interfaced with themicroprocessor system and CPU 38 without requiring additionalamplification, signal conditioning and A/D converters.

Referring now to FIG. 7, a two way communication system in accordancewith the principals of the present invention is shown. The physiologicaldata of an ambulatory patient is monitored utilizing monitoringapparatus 10 at a local site 58 and is transmitted to a remote computer32 located at a remote computer site 62 via communication network 34. Atthe remote computer site 62 a medical professional caregiver such as anurse, physician or nurse practitioner monitors the patient data andprovokes treatment in accordance with such data.

Operations to perform the preferred embodiment of the invention areshown in FIG. 8. Block 64 illustrates the operation of monitoring ormeasuring the ambulatory patient's physiological parameter. In oneembodiment of the invention, namely for chronic heart failure patients,the physiological parameter monitored is the patient's weight. However,it will be appreciated by those skilled in the art that thephysiological parameter may include blood pressure, EKG, temperature,urine output and any other.

Block 66 illustrates the operation of converting a monitored or measuredphysiological parameter from a mechanical input to an electronic outputby utilizing a transducing device. In one embodiment of the inventionthe transducing device is an electronic scale 18, which converts thepatient's weight into a useable electronic signal.

At block 68, the microprocessor system 24 processes the electronicsignal representative of the transduced physiological parameter. If theresulting parameter value is within certain preprogrammed limits themicroprocessor system 24 initiates communication within the remotecomputer 32 via the communication device 36 over the communicationnetwork 34.

Block 70 illustrates the operation whereby information such as wellnessparameters and physiological data are communicated between themonitoring apparatus 10 and the ambulatory patient. An exemplary list ofthe questions asked to the patient by the monitoring apparatus areprovided in Table 5.

Referring now to FIGS. 7 and 8, upon establishing communication betweenthe local monitoring apparatus 10, at the local site 58, and the remotecomputer 32, at remote site 62, block 72 illustrates the operation ofcommunicating or transmitting processed signals representative ofphysiological data and wellness parameters from the local site 58 to theremote site 62.

FIG. 9 is a sectional view the scale 18 portion of one embodiment of theinvention. The scale 18 comprises a top plate 11 and a base plate 12.The top plate 11 and the base plate 12 having a thickness “T”. A loadcell 100 is disposed between the top plate 11 and the base plate 12 andrests on support/mounting surfaces 96 and 98.

The load cell 100 is a transducer that responds to a forces applied toit. During operation, when a patient steps on the electronic scale 18,the load cell 100 responds to a force “F” transmitted through the topplate 11 and a first support/mounting surface 96. The support/mountingsurface 96 is contact with a first end on a top side of the load cell100. A force “F” that is equal and opposite to “F” is transmitted fromthe surface that the electronic scale 18 is resting on, thorough thebase plate 12 and a second support/mounting surface 98. The secondsupport/mounting surface 98 is in contact with a second end on a bottomside of the load cell 100. In one embodiment, the load cell 100 isattached to the top plate 11 and the base plate 12, respectively, withbolts that engage threaded holes provided in the load cell 100. In oneembodiment the load cell 100 further comprises a strain gage 102.

The strain gage 102 made from ultra-thin heat-treated metallic foils.The strain gage 102 changes electrical resistance when it is stressed,e.g. placed in tension or compression. The strain gage 102 is mounted orcemented to the load cell 100 using generally known techniques in theart, for example with specially formulated adhesives, urethanes, epoxiesor rubber latex. The positioning of the strain gage 102 will generallyhave some measurable effect on overall performance of the load cell 100.Furthermore, it will be appreciated by those skilled in the art thatadditional reference strain gages may be disposed on the load cell wherethey will not be subjected to stresses or loads for purposes oftemperature compensating the strain gage 102 under load. Duringoperation over varying ambient temperatures, signals from the referencestrain gages may be added or subtracted to the measurement signal of thestrain gage 102 under load to compensate for any adverse effects ofambient temperature on the accuracy of the strain gage 102.

The forces, “F” and “F”', apply stress to the surface on which thestrain gage 102 is attached. The weight of the patient applies a load onthe top plate 11. Under the load the strain gage(s) 102 mounted to thetop of the load cell 100 will be in tension/compression as the load cellbends. As the strain gage 102 is stretched or compressed its resistancechanges proportionally to the applied load. The strain gage 102 iselectrically connected such that when an input voltage or current isapplied to the strain gage 102, an output current or voltage signal isgenerated which is proportional to the force applied to the load cell100. This output signal is is then converted to a digital signal by A/Dconverter 15.

The design of the load cell 100 having a first end on a top sideattached to the top plate 11 and a second end on a bottom side attachedto the base plate 12 provides a structure for stressing the strain gage102 in a repeatable manner. The structure enables a more accurate andrepeatable weight measurement. This weight measurement is repeatablewhether the scale 18 rests on a rigid tile floor or on a carpeted floor.FIG. 10 illustrates one embodiment of the top plate 11 that providesfour mounting holes 106 for attaching the base plate 12 to one end ofthe load cell 100. The base plate 12 provides similar holes forattaching to the other end of the load cell 100. The top plate 11 andthe base plate 12 (not shown) each comprise a plurality of stiffeningribs 108 that add strength and rigidity to the electronic scale 18.

Table 1 shows multiple comparative weight measurements taken with theelectronic scale 18 resting on a tile floor and a carpeted floor withoutrubber feet on the scale 18. The measurements were taken using the sameload cell 100. The thickness “T” of the top plate 11 and supporting ribswas 0.125″ except around the load cell, where the thickness of thesupporting ribs was 0.250″. The thickness of the load cell 100support/mounting surfaces 96, 98 (FIG. 9) was 0.375″. As indicated inTable 1, with the scale 18 resting on a tile floor, the average measuredweight was 146.77 lbs., with a standard deviation of 0.11595.Subsequently, with the scale 18 resting on a 0.5″ carpet with 0.38″ padunderneath and an additional 0.5″ rug on top of the carpet, the averagemeasured weight was 146.72 lbs., with a standard deviation of 0.16866.

TABLE 1 Thick Scale Parts Around Load Cell 0.250″ TILE (lbs.) CARPET(lbs.) 146.9 146.7 146.7 147 146.9 146.6 146.8 146.7 146.6 146.6 146.8147 146.8 146.5 146.7 146.6 146.9 146.8 146.6 146.7  0.11595 (stddev) 0.16866 (stddev) 146.77 (average) 146.72 (average)

Table 2 shows multiple weight measurements taken with the scale 18 on atile floor and a carpeted floor with rubber feet on the bottom of thescale 18. The measurements were taken using the same load cell 100. Thethickness “T” of the top plate 11 was 0.125″ including the thicknessaround the load cell. As indicated in Table 2, with the scale 18 restingon a tile floor on rubber feet, the average measured weight was 146.62lbs., with a standard deviation of 0.07888. Subsequently, with the scale18 resting on a 0.5″ carpet with 0.38″ pad underneath and an additional0.5″ rug on top of the carpet, the average measured weight was 146.62lbs., with a standard deviation of 0.04216.

TABLE 2 Thin Scale Parts Throughout 0.125″ TILE (lbs.) CARPET (lbs.)146.7 146.7 146.7 146.7 146.6 146.6 146.6 146.6 146.6 146.6 146.6 146.6146.5 146.6 146.7 146.6 146.5 146.6 146.7 146.6  0.07888 (stddev) 0.04216 (stddev) 146.62 (average) 146.62 (average)

Table 3 shows multiple weight measurements taken with an off-the-shelfconventional electronic scale. As indicated in table 3, with theoff-the-shelf conventional scale resting on the tile floor, the averagemeasured weight was 165.5571 lbs., with a standard deviation of 0.20702.Subsequently, with the off-the-shelf conventional scale resting on a0.5″ carpet with 0.38″ pad underneath and an additional 0.5″ rug on topof the carpet, the average measured weight was 163.5143 lbs., with astandard deviation of 0.13093.

TABLE 3 Off-The-Shelf Conventional Scale TILE (lbs.) CARPET (lbs.) 165.9163.5 165.5 163.4 165.8 163.7 165.4 163.6 165.5 163.6 165.4 163.5 165.4163.3 — 163.4  0.20702 (stddev)  0.13093 (stddev) 165.5571 (average)163.5143 (average)  2.042857 (% of difference)  1.249345 (% ofdifference)

The summary in Table 4 is a comparative illustration of the relativerepeatability of each scale while resting either on a tile floor or on acarpeted floor.

TABLE 4 SUMMARY OF DATA: TILE VS. TRIAL TILE STDDEV CARPET STDDEV CARPETHeavy Scale Parts All 0.125″ Except Cell Around the Load Cell 0.250″ 1146.77 0.1159 146.72 0.1686 0.05 2 146.67 0.0823 146.72 0.1906 0.05 ThinScale Parts All 0.125″ 1 146.62 0.0788 146.62 0.04216 0.00 Off-The-ShelfConventional Scale 1 165.55 0.207 163.51 0.1309 2.04

The foregoing description was intended to provide a general descriptionof the overall structure of several embodiments of the invention, alongwith a brief discussion of the specific components of these embodimentsof the invention. In operating the apparatus 10, an ambulatory patientutilizes the monitoring apparatus 10 to obtain a measurement of aparticular physiological parameter. For example, an ambulatory patientsuffering from chronic heart failure will generally be required tomonitor his or her weight as part of in-home patient managing system.Accordingly, the patient measures his or her weight by stepping onto theelectronic scale 18, integrally located within the base plate 12 of themonitoring apparatus 10.

Referring now to FIG. 4, the modem 36 of the monitoring apparatus 10will only activate if the measured weight is within a defined range suchas +/−10 lbs, +/−10% or any selected predetermined value of a previousweight measurement. The patient's previous symptom free weight (dryweight) is stored in the memory 40. The dry weight is the patient'sweight whenever diuretics are properly adjusted for the patient, forexample. This prevents false activation of the modem 36 if a child, pet,or other person accidentally steps onto the electronic scale 18.

Upon measuring the weight, the microprocessor system 24 determineswhether it is within a defined, required range such as +/−10 lbs. or+/−10% of a previously recorded weight stored in memory 40. Themonitoring apparatus 10 then initiates a call via the modem 36 to theremote site 62. Communications is established between the localmonitoring apparatus 10 and the remote computer 32. In one embodiment ofthe invention, the patient's weight is electronically transferred fromthe monitoring apparatus 10 at the local site 58 to the remote computer32 at the remote site 62. At the remote site 62 the computer programcompares the patient's weight with the dry weight and wellnessinformation and updates various user screens. The program can alsoanalyze the patient's weight trend over the previous 1-21 days. Ifsignificant symptoms and/or excessive weight changes are reported, thesystem alerts the medical care provider who may provoke a change to thepatient's medication dosage, or establish further communication with thepatient such as placing a telephone to the patient. The communicationbetween the patient's location and the remote location may be one way ortwo way communication depending on the particular situation.

To establish the patient's overall condition, the patient is promptedvia the output device(s) 30 to answer questions regarding variouswellness parameters. An exemplary list of questions, symptoms monitoredand the related numerical score is provided in Table 5 as follows:

TABLE 5 Health Check Score Question Symptom Value Above Dry Weight?Fluid accumulation 10 Are you feeling short of breath? Dyspnea 10 Didyou awaken during the night Paroxysmal nocturnal dyspnea 5 short ofbreath? Did you need extra pillows last Congestion in the lungs 5 night?Are you coughing more than Congestion in the lungs 3 usual? Are yourankles or feet swollen? Pedal edema 5 Does your stomach feel bloated?Stomach edema 3 Do you feel dizzy or lightheaded? Hypotension 5 Are youmore tired than usual? Fatigue 2 Are you taking your medication?Medication compliance 7 Has your appetite decreased? Appetite 2 Are youreducing your salt intake? Sodium intake 1 Did you exercise today?Fitness 1

At the remote site 62 the medical professional caregiver evaluates theoverall score according to the wellness parameter interrogationresponses (as shown in Table 5). For example, if the patient's totalscore is equal to or greater than 10, an exception is issued and willeither prompt an intervention by the medical professional caregiver inadministering medication, or prompt taking further action in the medicalcare of the patient.

The output device(s) 30 varies based on the embodiment of the invention.For example, the output device may be a synthetic speech generator 33.As such, the wellness parameters are communicated to the patient via theelectronic synthetic speech generator 33 in the form of audible speech.It will be appreciated that electronic speech synthesizers are generallywell known and widely available. The speech synthesizer convertselectronic data to an understandable audible speech. Accordingly, thepatient responds by entering either “YES” or “NO” responses into theinput device 28, which may include for example, an electronic keypad 29.However, in one embodiment of the invention, the input device may alsoinclude a generic speech recognition device such as those made byInternational Business Machines (IBM), Dragon Systems, Inc. and otherproviders. Accordingly, the patient replies to the interrogations merelyby speaking either “YES” or “NO” responses into the speech recognitioninput device.

In embodiments of the invention that include electronic display 31 as anoutput device 30, the interrogations as well as the responses aredisplayed and/or scrolled across the display for the patient to read.Generally, the electronic display will be positioned such that it isviewable by the patient during the information exchanging processbetween the patient and the remote computer 32.

Upon uploading the information to the remote computer 32, the medicalprofessional caregiver may telephone the patient to discuss, clarify orvalidate any particular wellness parameter or physiological data point.Furthermore, the medical professional caregiver may update the list ofwellness parameter questions listed in Table 5 from the remote site 62over the two way communication network 34. Modifications are transmittedfrom the remote computer 32 via modem 35, over the communication network34, through modem 36 and to the monitoring apparatus 10. The modifiedquery list is then stored in the memory 40 of the microprocessor system24.

Two-Way Communication

FIG. 11 is presented in furtherance of the previous discussion regardingtwo-way communication between the patient monitoring apparatus and thecentral computer. FIG. 11 is a high-level depiction of the monitoringsystem, and may be used as a starting point for a more detaileddiscussion of the two-way communication schemes.

As can be seen from FIG. 11, the system comprises a patient monitoringapparatus 1100 and a central computer 1102. The central computer 1102 ishoused within a facility 1104 that is located remote from the patientmonitoring apparatus 1100. For example, the patient monitoring apparatus1100 may be located in the home of an ambulatory patient 1105, while thecentral computer 1102 is located in a cardiac care facility 1104.

As described previously, the patient monitoring apparatus 1100 iscomposed of a central processor unit 1106, which is in communicationwith an input device 1108, an output device 1110, and a sensor 1112. Asalso previously described the sensor 1112 may be a transducer used toconvert a physiological measurement into a signal, such as an electricalsignal or an optical signal. For example, the sensor 1112 may comprise aload cell configured with a strain gauge, arranged to determine thepatient's 1105 weight; the sensor 1112 would represent the patient's1105 weight as an electrical signal.

As discussed previously, the output device 1110 may be used to promptthe patient 1105 with questions regarding the patient's wellness. Theoutput device 1110 may consist of a visual display unit that displaysthe questions in a language of the patient's 1105 choosing.Alternatively, the output device 1110 may consist of an audio outputunit that vocalizes the questions. In one embodiment, the audio outputunit 1110 may vocalize the questions in a language of the patient's 1105choosing.

As discussed previously, the input device 1108 may be used to receivethe patient's 1105 response to the questions posed to him/her 1105. Theinput device 1108 may consist of a keyboard/keypad, a set of buttons(such as a “yes” button and a “no” button), a touch-screen, a mouse, avoice digitization package, or a voice recognition package.

The patient monitoring apparatus 1100 communicates with the centralcomputer 1102 via a network 1118; the patient monitoring apparatus 1100uses a communication device 1114 to modulate/demodulate a carrier signalfor transmission via the network 1118, while the central computer uses acommunication device 1116 for the same purpose. Examples of suitablecommunication devices 1114 and 1116 include internal and external modemsfor transmission over a telephone network, network cards (such as anEthernet card) for transmission over a local area network, a networkcard coupled to some form of modem (such as a DSL modem or a cablemodem) for transmission over a wide area network (such as the Internet),or an RF transmitter for transmission to a wireless network.

A system composed as described above may be programmed to permit two-waycommunication between the central computer 1102 and the patientmonitoring apparatus 1100. Two-way communication may permit the centralcomputer 1102 to upload a customized set of questions or messages forpresentation to a patient 1105 via the monitoring apparatus 1100. Forexample, in the case where the monitoring apparatus 1100 monitors thepatient's 1105 weight, a sudden increase in weight following a highsodium meal might cause the health care provider to send a customizedquestion for presentation to the patient 1105: “Did consume any saltyfood in the last 24 hours?” Such a customized question could bepresented to the patient 1105 the next time the patient uses themonitoring apparatus 1100 or could be presented to the patient in realtime (these options are discussed in greater detail, below).Additionally, a customized message may be scheduled for delivery atcertain times (such as every Friday of the week—this is also discussedin greater detail, below). Further, these customized messages may beentered on the fly or selected from a list (this is also discussed ingreater detail below).

FIG. 12 depicts a flow of operations that permits two-way communicationbetween the central computer 1102 and the monitoring apparatus 1100.FIG. 12 presents a flow of interactions between the central computer1102 and the monitoring apparatus 1100 on a first day (operation1200-1210) and on a second day (1212-1222). In the discussion thatfollows, it will be assumed that the monitoring apparatus 1100 is formedas a scale that monitors a patient's weight, although this need not bethe case. It is further assumed that the patient 1105 measures his/herweight on a daily basis (although, in principle, any frequency ofmeasurement would operate within the bounds of this embodiment), afterwhich a communication session is initiated between the central computer1102 and the monitoring apparatus 1100.

On the first day, operation begins with the patient 1105 stepping on thescale, as shown in operation 1200; the patient's 1105 weight ismeasured, transduced, and stored by the central processing unit 1106.Next, in operation 1202, a memory device is accessed by the centralprocessing unit 1106 for the purpose of retrieving a set of customizedquestions downloaded during the previous day. Each question is asked, ina one-by-one fashion, and a corresponding answer received from thepatient 1105 via the input device 1108 is recorded (if the customizedprompt is merely a statement, the statement is output to the patient andno answer is requested of the patient 1105). Next, in operation 1204, acommunication session is initiated. The session may be initiatedmanually (for example, by the patient pushing a button); the session maybe initiated automatically by the scale at a specific time of the day(such as at midnight, after the patient 1105 is assumed to have weightedhimself/herself and recorded his/her answers to the customized wellnessquestions); the session may be initiated automatically by the scale uponthe patient 1105 answering the final question; finally, the session maybe initiated by the central computer 1102 at a specific time of the day(such as at midnight, after the patient 1105 is assumed to have weightedhim/herself and recorded his/her answers to the customized wellnessquestions). During the communication session, customized questions to beasked to the patient 1105 the next day are downloaded by the monitoringapparatus 1100, as depicted in operation 1206. Additionally, the answersrecorded in operation 1202 are uploaded to the central computer 1102, asdepicted in operation 1208. Finally, in operation 1210, thecommunication session is terminated.

On the second day, the same set of operations takes place, withreferences to previous and future days now referring to “DAY 1” and “DAY3,” respectively: in operation 1214, the set of questions downloadedduring the first day (in operation 1206) are asked, and the answers arerecorded; similarly, in operation 1218, a set of customized questions tobe asked on a third day are uploaded to the monitoring apparatus 1100.

Downloading operations (such as operations 1206 and 1218) and uploadingoperations (such as operation 1208 and 1220) may be influenced by theform of input device 1108 or output device 1110 chosen for use by themonitoring apparatus 1100. For example, if the output device 1110 is avisual display, then a set of data representing the text of the questionis transmitted to the monitoring apparatus 1100 during the downloadingoperations 1206 and 1208. If, however, the output device 1110 is anaudio output device, then a set of data representing a vocalization ofthe question may be transmitted to the monitoring apparatus 1100 duringthe downloading operations 1206 and 1208. In any case, the data beingtransmitted to the monitoring apparatus 1100 may be compressed for thesake of preservation of bandwidth. Similar considerations apply to theuploading operations 1208 and 1220, based upon the choice of inputdevice 1108. If the input device 1108 is a set of buttons (for example,a “yes” button and a “no” button), then the data uploaded to the centralcomputer 1102 is representative of the button that was pushed. If theinput device 1108 is a voice digitization package, then the datauploaded to the central computer 1102 is representative of the digitizedvoice pattern from the patient 1105. As in the case of the downloadingoperations, the data being uploaded to the central computer 1102 may becompressed for the sake of preservation of bandwidth.

FIGS. 13, 14, and 15 depict other flows of operation for two-waycommunication between a central computer 1102 and a patient monitoringapparatus 1100. The considerations regarding the format of the databeing uploaded and downloaded also apply to the schemes illustratedtherein.

FIG. 13 depicts a flow of operations that permits two-way communicationbetween the central computer 1102 and the monitoring apparatus 1100.FIG. 13 presents a flow of interactions between the central computer1102 and the monitoring apparatus 1100 on a first day (operation1300-1314) and on a second day (1316-1328). In the discussion thatfollows, it will be assumed that the monitoring apparatus 1100 is formedas a scale that monitors a patient's weight, although this need not bethe case. It is further assumed that the patient 1105 measures his/herweight on a daily basis (although, in principle, any frequency ofmeasurement would operate within the bounds of this embodiment).

On the first day, operation begins with a communication session betweenthe central computer 1102 and the monitoring apparatus 1100 beinginitiated, as shown in operation 1300. During this communicationsession, a set of customized questions to be asked to the patient 1105later in the day are downloaded by the monitoring apparatus 1100, asdepicted in operation 1302. Then, in operation 1304, the communicationsession is terminated. The communication session initiated in operation1300 may be initiated by the monitoring apparatus. Additionally, thesession may be initiated at a time of the day that justifies theassumption that any new customized questions would have already beenentered for downloading by the monitoring device 1100. At some point inthe day after the termination of the communication session, the patient1105 weighs himself on the monitoring apparatus, as shown in operation1306, and the weight is stored by the central processor unit 1106. Next,in operation 1308, a memory device is accessed by the central processingunit 1106 for the purpose of retrieving the set of customized questionsdownloaded earlier in the day during operation 1302. Each question isasked, in a one-by-one fashion, and a corresponding answer received fromthe patient 1105 via the input device 1108 is recorded. Next, inoperation 1310, a communication session is initiated. As in the schemedepicted in FIG. 12, the session may be initiated manually orautomatically. During this session, the answers recorded in operation1308 are uploaded to the central computer 1102, as depicted in operation1312. Finally, in operation 1314, the communication session isterminated.

As can be seen from FIG. 13, the set of operations performed on thesecond day (operations 1316-1328) are identical to the operationsperformed on the first day (operations 1300-1314).

FIG. 14 depicts another flow of operations that permits two-waycommunication between the central computer 1102 and the monitoringapparatus 1100. The flow of operations depicted in FIG. 14 is the sameas that which is shown in FIG. 13, with minor exceptions. The flowdepicted in FIG. 14 is arranged such that the central computer 1102initiates the first communication session (in operation 1400), duringwhich a set of customized questions are downloaded by the monitoringdevice; however, later in the day, the monitoring device 1100 initiatesthe second communication session (in operation 1410), during which thepatient's 1105 weight and answers to the customized questions aretransmitted to the central computer 1102. This scheme has the advantageof allowing the central computer 1102 to initiate the session duringwhich the customized questions are uploaded to the monitoring apparatus1100, thereby ensuring that the communication session occurs after thenew questions have been entered by the health care provider (if themonitoring apparatus 1100 initiates the communication session, as inFIG. 13, the session may be initiated before the new questions areentered). Just as in the scheme depicted in FIG. 13, the scheme depictedin FIG. 14 employs the same set of operations from day to day.

FIG. 15 depicts a flow of operations that permits real-time two-waycommunication between the central computer 1102 and the monitoringapparatus 1100. In the discussion that follows, it will be assumed thatthe monitoring apparatus 1100 is formed as a scale that monitors apatient's weight, although this need not be the case. It is furtherassumed that the patient is free to weight himself/herself at any timeduring the day and that the measured weight will be stored. The schemedepicted in FIG. 15 permits the patient 1105 to initiate a communicationsession, during which the health care provider may, via the centralcomputer, enter questions that are posed to the patient in real-time viathe monitoring apparatus 1100. The communication session does not enduntil the health care provider indicates that it has no furtherquestions to ask the patient. Thus, the health care provider may adaptits questions in real-time, based upon the answers received from thepatient 1105.

Operation begins with a communication session between the centralcomputer 1102 and the monitoring apparatus 1100 being initiated, asshown in operation 1500. Next, in operation 1502, the central computer1102 generates a visual cue on its graphical user interface to indicatethat a particular patient is logged in. A health care provider/operatorat the central computer 1102 is thereby made aware of his/heropportunity to prompt the patient 1105 with customized questions inreal-time. Subsequently, in operation 1504, the weight of the patient1105 is uploaded to the central computer. As mentioned earlier, thepatient 1105 is assumed to have weighed himself/herself at a point inthe day prior to the initiation of the communication session inoperation 1500. This permits the patient 1105 to consistently measurehis/her weight at a given point in the day (perhaps immediately uponwaking in the morning), yet answer questions regarding his/her symptomsat a point later in the day, so that the patient 1105 has had a chanceto judge his/her general feeling of health/illness before answering thequestions. Of course, this is an optional feature of the invention andis not crucial. In operation 1506, a first customized question isuploaded to the monitoring apparatus. During operation 1506, a healthcare provider/operator may enter a question to be posed to the patient1105; it is immediately transmitted to the monitoring apparatus 1100 andposed to the patient 1105. In operation 1508, the patient's answer istransmitted to the central computer 1102. Next, in operation 1510, theoperator/health care provider at the central computer 1102 indicateswhether or not any additional questions are pending. If so, control ispassed to operation 1506, and the additional questions are asked andanswered. Otherwise, the communication session is terminated inoperation 1512.

Scheduling of Questions and Presentation of Trending Data

FIG. 16 illustrates a scheme of asking customized questions andcollecting the answers thereto. As can be seen from FIG. 16, a set ofcustomized questions may be downloaded to a monitoring device 1100 onDAY N. The customized questions will be asked to the patient 1105, andthe answers recorded either later in the day on DAY Nor on DAY N+1(depending upon the particular 2-way scheme employed). The answers tothe customized questions are retrieved by the central computer 1102 onDAY N+1. The particular questions asked from day-to-day may vary, basedupon instruction from the health care provider.

FIG. 17 illustrates a graphical user interface that may be used inconjunction with software running on the central computer 1102 for thepurpose of scheduling the questions to be uploaded each day to themonitoring apparatus 1100 (as illustrated by FIG. 16) for questioning ofthe patient 1105. As can be seen from FIG. 17, a message field 1700 isprovided that permits an operator/health care provider to enter acustomized message to be uploaded to the monitoring apparatus 1100. Astart-date field 1702 and an end-date field 1704 define the periodduring which the questions are to be asked; a frequency field indicates1706 the frequency with which the question entered in field 1700 is tobe asked. For example, if the message field 1700 contained the question“Did you remember to take your medication this week?”, the start-datefield 1702 contained “8/1/2001,” the end-date field 1704 contained“9/1/2001,” and the frequency field 1706 contained “Friday,” then thepatient 1105 would be prompted with the question “Did you remember totake your medication this week?” on each Friday between 8/1/2001 and9/1/2001. An alert field 1708 permits an operator/health care providerto define an answer that, when provided by patient 1105, sends an alertto the health care provider. For example, in the case where the questionwas “Did you remember to take your medication this week?”, the alertfield 1708 may contain the answer “No,” so that the health care providerwould be alerted if the patient 1105 indicated that he/she had failed totake his/her medication during the week.

The data entered via the graphical user interface depicted in FIG. 17 isstored in a database. The data may be organized based upon dates fortransmission to the monitoring device 1100, so that all of the questionsto be uploaded to the monitoring device 1100 on a given day may beeasily acquired. The data may be sorted other ways, as well. Forexample, the data may be sorted based upon which questions were asked onwhich days, so that a presentation of the questions posed to a patienton a given day (or set of days) and the corresponding answers theretomay be easily developed. A graphical user interface that provides such apresentation is depicted in FIG. 18.

FIG. 18 depicts a graphical user interface that presents all of thecustomized questions presented to a patient over a particular durationand all of the corresponding answers for each day. This sort ofinformation is referred to as “trending data,” because it permits ahealth care provider to quickly determine if a particular symptom beganregularly exhibiting itself on a certain day, or if a particular symptomis randomly exhibited. As can be seen from FIG. 18, a message field 1800is provided which presents a customized question that was asked duringthe timeframe indicated by the date bar 1801. Under each date presentedin the date bar 1801 is an answer field 1802-1816, which presents thepatient's 1105 answer to the question presented in the message field1800. If a particular question was not asked on a given day, thegraphical user interface may so indicate. For example, an answer field1802-1816 may be grayed out on a particular day if the question was notasked, or an answer field may be highlighted on days in which theparticular question was asked. As described earlier, the data used topopulate fields 1800-1816 is retrieved from a database containing eachof the questions asked on a given day and each of the correspondinganswers.

Other reporting schemes and graphical user interfaces are taught in U.S.application Ser. No. 09/399,041 filed on Sep. 21, 1999, entitled“MEDICAL WELLNESS PARAMETERS MANAGEMENT SYSTEM, APPARATUS AND METHOD,”which is hereby incorporated by reference in its entirety.

Collapsible Scale/Carpet-Spike Pads

FIG. 19 depicts a collapsible scale 1900 with integrated carpet-spikepads, in accordance with one embodiment of the present invention. As canbe seen from FIG. 19, a collapsible scale 1900 is comprised of a base1902, upon which a patient 1105 stands in order to weighhimself/herself. Perpendicular to the base 1902 is a support member 1904which elevates a housing 1906 at about waist level. The housing 1906 maycontain an input device, an output device, a processor, and acommunication device. The support member 1904 is coupled to the base1902 via a hinge 1914. The hinge 1914 enables the support member 1904 tofold into a position approximately parallel (though not necessarilycoplanar) with the base 1902, thereby permitting the scale 1900 to fiteasily (and in one piece) into a box suitable for shipping. Anotheradvantage of the collapsible embodiment is that it relieves the patient1105 of having to assemble the scale at his/her home.

The base 1902 may be composed of top plate 1908, upon which the patient1105 stands, and a base plate 1910. The hinge 1914 may be coupled to thesupport member 1904 and the top plate 1908, so that if the patient leansupon the housing 1906, the force is conducted down the support member1904, though the hinge 1914, and to the top plate 1908, therebypreserving the validity of the weight measurement. Alternatively, thetop plate 1908 may have member 1912 rigidily coupled thereto. In such acase, the hinge 1914 may be coupled between the support member 1904 andthe rigidly coupled member 1912.

In one embodiment of the scale 1900, a plurality of carpet-spike pads1916 are attached to the bottom of the base 1902. A carpet-spike pad1926 is a disk with a plurality of spikes that protrude downwardlytherefrom. The carpet-spike pads 1916 improve the stability of the scale1900 upon carpet-like surfaces, thereby enhancing the accuracy andrepeatability of measurements taken therewith. The carpet-spike pads1916 may be attached to the base 1902 by an adhesive, by force fit, ormay be integrated into the base 1902 itself.

Question Hierarchies

FIG. 20 depicts an embodiment of the patient monitoring apparatus 2000,in which the housing 2002, the output device 2004, and the input device2006 stand alone as a complete unit. (A physiologicalparameter-measuring unit, such as a scale, is not required to interfacewith the unit 2000, but may be added). As in other embodiments,circuitry for operation of the device is held within the housing 2000.The output device 2002 may be a display, such as an LCD screen, and mayinclude an audio output unit. The input device 2006 is depicted as twobuttons, a “YES” button and a “NO” button. One skilled in the artunderstands that the input device may be a keypad, a mouse, a button, aswitch, a light pen, or any other suitable input device. In oneembodiment of the invention, the input and output devices 2004 and 2006are combined into a touch-screen device.

The patient monitoring apparatus 2000 of FIG. 20 may be programmed tocontain a plurality of question hierarchies, each of which relates to ahealth-related symptom. Each hierarchy contains a set of questions. Eachquestion in a given hierarchy is aimed at characterizing a particularsymptom in a particular way. Certain questions within a hierarchy may bedeemed moot (and thus will not be asked) in light of a patient's answerto a previous question. Details regarding question hierarchies will bediscussed in greater detail, below.

By programming the patient monitoring apparatus 2000 to contain aplurality of question hierarchies, the unit 2000 attains greatflexibility as a tool for monitoring chronic diseases of many varieties.A particular chronic disease may be monitored by asking questions aboutsymptoms associated with the disease. Thus, for example, the unit 2000may be made to monitor the health status of a patient with chronicobstructive pulmonary desease (COPD) by querying the patient, usingquestions extracted from question hierarchies relating to symptomsassociated with COPD. The same unit 2000 may be used to monitor apatient with diabetes by asking questions extracted from a different setof question hierarchies, which are related to symptoms associated withdiabetes.

FIG. 21 is a high-level depiction of a monitoring system employing theembodiment 2000 depicted in FIG. 20, and may be used as a starting pointfor a more detailed discussion of the patient monitoring apparatus 2000.

As can be seen from FIG. 21, the system comprises a patient monitoringapparatus 2000 and a central computer 2100. The central computer 2100 ishoused within a facility 2102 that is located remote from the patientmonitoring apparatus 2000. For example, the patient monitoring apparatus2000 may be located in the home of an ambulatory patient 2104, while thecentral computer 2100 is located in a health care facility 2102.

As described previously, the patient monitoring apparatus 2000 iscomposed of a central processor unit 2106, which is in communicationwith an input device 2006, an output device 2004, and a memory device2108. The memory device 2108 has a plurality of question hierarchiesstored within it, as discussed more fully, below.

As discussed previously, the output device 2004 may be used to promptthe patient 2104 with questions regarding the patient's wellness. Theoutput device 2004 may consist of a visual display unit that displaysthe questions in a language of the patient's 2104 choosing.Alternatively, the output device 2004 may consist of an audio outputunit that vocalizes the questions. In one embodiment, the audio outputunit 2004 may vocalize the questions in a language of the patient's 2104choosing.

The patient monitoring apparatus 2000 communicates with the centralcomputer 2100 via a network 2110; the patient monitoring apparatus 2000uses a communication device 2112 to modulate/demodulate a carrier signalfor transmission via the network 2110, while the central computer uses acommunication device 2114 for the same purpose. Examples of suitablecommunication devices 2112 and 2114 include internal and external modemsfor transmission over a telephone network, network cards (such as anEthernet card) for transmission over a local area network, a networkcard coupled to some form of modem (such as a DSL modem or a cablemodem) for transmission over a wide area network (such as the Internet),or an RF transmitter for transmission to a wireless network.

A system composed as described above may be programmed to carry onperiodic (e.g., daily) questioning of a patient 2104, with respect tothe patient's 2104 perception regarding his or her own status vis-à-visa particular set of symptoms. For example, a patient suffering from COPDis likely to experience shortness of breath, both during the day andduring the night (amongst many other symptoms). Thus, the system mayquestion the patient 2104 about his own percpetions regarding hisshortness of breath. The questions used to determine the patient's 2104judgment about his own shortness of breath during the day are containedin a first question hierarchy. Similarly, questions related to thepatient's 2104 shortness of breath during the night are contained in asecond question hierarchy.

The first hierarchy, which is related to shortness of breath during theday, may be structured as follows:

TABLE 5 Question Hierarchy: Shortness of Breath During the Day Question#1 Are you feeling more short of breath? Question #2 Do you feel moreshort of breath in response to physical exertion? Question #3 Do youfeel more short of breath during periods of rest? Question #4 Doesstress make you feel more short of breath?

Each of the questions in the hierarchy is related to day-time shortnessof breath. The first question is broadly focussed, simply asking “Areyou feeling more short of breath?” Clearly, if the patient 2104 were toanswer “no” to such a question, the remainder of the questions would beunnecessary. Thus, the system may be designed to prevent the remainingquestions from being asked (this will be discussed in greater detail,bleow). Question #2 asks a question that is more particularized thanquestion #1: “Do you feel more short of breath in response to physicalexertion?” An affirmative answer to this question is more serious, andprovides more particularized information, than an affirmative answer tothe broader query presented in question #1. Although not essential, eachquestion hierarchy may be constructed in accordance with this paradigm:(1) a negative answer to a preceeding questions negates the need to askany additional questions in the hierarchy; (2) successive questionsrelate to increasingly more particularized aspects of a given symptom;and (3) successive questions relate to an increasing severity level of agiven symptom.

FIG. 22 depicts the partial contents of the memory device 2108 of FIG.21. As can be seen from FIG. 21, the memory device 2108 is programmedwith a set of question hierarchies 2200. In the example depicted in FIG.22, the memory device is programmed with six question hierarchies 2201,2202, 2203, 2204, 2205, and 2206 (collectively referred to as “the setof question hierarchies 2200”). As described previously, each hierarchyrelates to a symptom condition to be monitored, meaning that the numberof question hierarchies stored in the memory device 2108 is dependentupon the number of symptoms to be monitored.

Hierarchy 2201 has a basic structure that includes a first question Q1,followed by a first decision point D1. At decision point D1, the patientmonitoring apparatus 2000 decides whether or not to ask the subsequentquestion, Q2. For example, Q1 may be a question that reads “Are youfeeling more short of breath?” If the patient 2104 answers “no,” thisanswer is analyzed at decision point D1, and the questioning terminatesat terminal point T1. Otherwise, the questioning continues with the nextquestion, Q2, and the process continues.

Each of the hierarchies 2200 depicted in FIG. 22 posssess theabove-recited structure, although other structures are possible, some ofwhich are described below. One skilled in the art understands thatalthough each hierarchy 2200 is depicted as consisting of threequestions, a hierarchy may consist of any number of questions, includinga single question.

As depicted in FIG. 22, the memory device 2108 is in data communicationwith the monitoring device's 2000 microprocessor 2106, which, in turn,is in data communication with a remote computer 2100 (not depicted inFIG. 22) via a network 2110 and via a communication device 2112 (alsonot depicted in FIG. 22). The remote computer 2100 transmits a symptomidentifier 2208 to the monitoring device's 2000 microprocessor 2106. Thesymptom identifier 2208 corresponds to a question hierarchy 2200. Forexample, a symptom identifier with a value of “1” may correspond tohierarchy 2201, while a symptom identifier with a value of “2”corresponds to hierarchy 2202, etc. The microprocessor 2106 responds tohaving received a symptom identifier 2202 by executing the correspondinghierarchy (i.e., asking a question within the hierarchy, and decidingwhether or not to ask a subsequent question therein). Thus, the patientmonitoring device 2200 may be made to execute n number of questionhierarchies by transmitting to it n number of symptom identifiers.

Given that a known set of symptoms are correlated with any given chronicdisease, the patient monitoring device 2000 may be tailored to monitorthe health status of a patient 2104 with a particular disease byexecuting question hiearchies 2200 relating to symptoms correspondingwith the patient's 2104 particular disease. Thus, the remote computer2100 may be programmed with software that presents a menu for eachpatient 2104. The menu allows the health care provider to select fromamong a set of chronic diseases. Based upon the selected chronicdisease, the remote computer 2100 transmits one or more symptomidentifiers (which correspond to symptoms known to accompany theselected disease) to the patient monitoring apparatus 2000. The remotecomputer 2100 receives the patient's 2104 responses, and scores theresponse in accordance with a scoring algorithm, discussed in detailbelow. Based upon the outcome of the score, an exception report may begenerated, meaning that a health care provider will be notified of thepatient's possible need for assistance. Alternatively, the remotecomputer 2100 may be programmed to transmit an e-mail message or anumeric page to communicate the information concerning the patient 2104.In principle, any data transmission communicating the patient's 2104potential need for assistance may be transmitted.

In certain situations, it may be desirable for the patient monitoringdevice 2000 to obtain information regarding a physiological paramter.For example, if a particular chronic disease is associated with a fever,the patient monitoring device may want to know information concerningthe patient's 2104 body temperature. Two general approaches exist forgaining information concerning a physiological paramter. The monitoringsystem 2000 may be adapted for interfacing with a physiologicalparameter-measuring unit, as has been disclosed with reference to otherembodiments of the invention. The parameter-measuring unit can thendirectly measure the physiological parameter and transmit the data tothe central computer 2100. Many times, this is an appropriate approach.Accordingly, according to one embodiment of the invention, themicroprocessor 2106 may interface with a physiologicalparameter-measuring device, such as a scale or a thermometer, aspreviously described herein. On the other hand, oftentimes it ispossible to ask the patient to measure the parameter for himself (e.g.,take his own temperature). This approach has an advantage, in that thecost of obtaining the information is minimized. This approach isparticularly useful when an exact measurement of a physiologicalparameter is not as useful as simply knowing whether the parametercrosses some threshold. Under these circumstances, the cost of directlyobtaining precise information may outweigh the financial benefit ofknowing such information. Thus, as depicted in FIG. 23, a questionhierarchy 2200 may be designed to ask a patient whether one of hisphysiological parameters exceeds a threshold, T.

The question hierarchy 2200 depicted in FIG. 23 is similar to thequestion hierarchies 2200 discussed with reference to FIG. 22. Thequestion hierarchy 2200 corresponds to a symptom identifier 2208, whichis transmitted to the patient monitoring device 2000 by a remotecomputer 2100. The hierarchy 2200 possesses several questions Q1, Q2,and Q3, some of which may go unasked, if a decision point D1, D2, or D3terminates the flow of questioning by transferring execution flow to aterminal point T1, T2 or T3. Of particular note in the questionhierarchy 2200 of FIG. 23 is the first question, Q1, and the firstdecision point D1. The first question, Q1, asks the patient 2104 if aparticular physiological parameter of his exceeds a given threshold, T.The value represented by T is transmitted to the patient monitoringdevice 2000 by the remote computer 2100, as is depicted by thresholddatum 2300. Therefore, to invoke this particular hierarchy 2200, theremote computer should transmit both a symptom identifier 2208 and athreshold datum 2300. In response, the patient monitoring device 2000responds by asking the patient 2104 if his particular physiologicalparamter exceeds the threshold, T. Next, as is depicted by decisionpoint D1, the patient monitoring device 2000 determines whether or notto proceed with further questions, on the basis of whether or not theparameter exceeded the threshold, T.

Another situation likely to arise in the context of monitoring a patient2104 with a chronic illness is that the patient 2104 is to be queriedregarding his faithfulness to a prescribed health care regimen. Forexample, if the patient 2104 is a diabetic, the patient is likely to beon a strict diet. The patient monitoring device 2000 may be programmedto ask the patient 2104 if he has been following his diet. If thepatient 2104 answers “yes,” the device 2000 may respond by praising thepatient 2104—a tactic that may be particularly advantageous for youngpatients. On the other hand, if the patient 2104 answers “no,” thedevice 2000 may respond by reminding the patient 2104 to adhere to hisdiet.

FIG. 24 depicts a question hierarchy 2200 designed to achieve theresults of praising a patient 2104 for adhering to a prescribed regimen,or reminding the patient 2104 of the importance of adhering thereto. Ofparticular note in the question hierarchy 2200 depicted in FIG. 24 isthe first question, Q1. The first question, Q1, asks the patient 2104 ifhe has been adhering to a health care regimen (such as, a diet or amedication regimen). Next, at decision point D1, flow of execution isadjusted based upon whether or not the patient 2104 has been adhering tothe regimen. If the patient 2104 has been adhering to the regimen, thepatient 2104 is presented with a statement, S1, praising the patient.Otherwise, the patient 2104 is presented with a statement, S2, remindingthe patient 2104 to adhere to his regimen. In either event, executionflow is passed to the second question, Q2, and hierarchy executioncontinues in accordance with the flow described with reference to FIG.22.

FIG. 25 depicts a question hierarchy 2200 that has been modified topermit the remote computer 2100 to command specific questions within thehierarchy 2200 to be asked, regardless of any answer that may have beenpreviously given by the patient 2104. To achieve this result, the remotecomputer 2100 should transmit a symptom identifier 2208 corresponding tothe question hierarchy 2200. Additionally, a question set 2500 should betransmitted. The question set 2500 may define a set of questions to beforced “on.” For example, the question set 2500 may be {3, 5}, meaningthat questions 3 and 5 are to be asked, no matter what the patient 2104has previously answered.

Continuing the discussion assuming that a question set 2500 of {3, 5}had been transmitted, execution of the hierarchy commences with theasking of the first question, Q1. Next, at decision point D1, thepatient's 2104 answer to the first question is assessed to determinewhether the subsequent question in the hierarchy should be asked. If theanswer is such that ordinarily none of the remaining questions should beasked, execution would typically flow to terminal point T1. However, inthis embodiment, a second decision point, D2, is interposed betweendecision point D1 and terminal point T1. At the second decision point,D2, it is determined whether the question set 2500 contains a questionnumber that is higher than the question number that was just asked. Inthe case of the present example, the question set 2500 contains two suchquestion numbers, because question numbers 3 and 5 are higher than thepresent question number, 1. If the question set 2500 does contain aquestion number that is higher than the question number just asked, thenexecution flows to the smallest such question number (in this case,question number 3, Q3). Thereafter the process repeats, thereby ensuringthat each of the question numbers in the question set will be asked.

FIG. 26 depicts a question hierarchy 2200 that has been modified topermit the remote computer 2100 to command a specific sequence in whichthe questions within the hierarchy 2200 should be asked. To achieve thisresult, the remote computer 2100 should transmit a symptom identifier2208 corresponding to the question hierarchy 2200. Additionally, asequence set 2600 should be transmitted. The sequence set 2600 is a setof data defining the order in which the questions are to be asked. Forexample, the sequence set 2600 may be {3, 1, 2}, meaning that thequestion that would ordinarily be asked third should be asked first,that the question that would ordinarily be asked first should be askedsecond, and that the question that would ordinarily be asked secondshould be asked third.

Continuing on with the example, execution of the hierarchy 2200 of FIG.26 commences with a look-up operation, L1. During the look-up operationL1, the first element of the sequence set 2600 is used to index into anarray containing the questions within the hierarchy. In the presentexample, since “3” is the first element of the sequence set, the thirdquestion from the array is retrieved. Next, the retrieved question(identified as Q1 in FIG. 26) is asked, and execution of the hierarchyproceeds as has been generally described with reference to FIG. 22.Thus, by inserting a look-up operation L1, L2, or L3 prior to eachquestioning operation Q1, Q2, or Q3, any desired sequence of questioningmay be commanded.

The question hierarchies disclosed in FIGS. 22-26 may be programmed intothe memory device 2108 of the patient monitoring device 2000, therebyobviating the need to transmit the text of the questions from thecentral computer 2100 to the patient monitoring device 2000. One skilledin the art understands that the question hiearchies 2200 may beimplemented in the form of an application-specific integrated circuit,as well. Optionally, the questions within the hierarchies 2200 maywritten to be answered with either a “yes” or “no,” achieving theadvantage of simplifying the input required from the patient 2104, andthereby necessitating only “yes” or “no” buttons for the input device2006. Further, any of the preceeding question hierarchies 2200 forms maybe combined.

As described earlier, the memory device 2108 may store each of thequestion hierarchies 2200 in a plurality of languages, so as to permitpatients 2104 of many nationalities to use the device 2000. If theoutput device 2004 is an audio output unit, the questions within each ofthe question hierarchies 2200 may be stored in a digital audio format inthe memory device 2108. Accordingly, the questions are presented to thepatient 2104 as a spoken interogatory, in the language of the patient's2104 choice.

FIG. 27 depicts a method by which the patient's 2104 answers to thequestions presented in the hierarchies 2200 may be analyzed. Asmentioned earlier, depending upon the outcome of the analysis, anexception report may be issued and a health care provider may benotified. According to the method depicted in FIG. 27, during operation2700 a point value is assigned to each question in each of the invokedquestion hierarchies 2200. The points assigned to a given question are“earned” by a patient 2104, if the patient answers the question in aparticular way. Otherwise, no points are earned. For example, anaffirmative response to the question “are you experiencing shortness ofbreath?” may be worth 10 points, while a negative response to thatquestion is worth nothing. A standard point value may be assigned toeach question (each question has a point value of 10, for instance), ordifferent questions may be assigned different point values (a firstquestion is worth 10 points, while a question directed toward a moreserious issue may be worth 30 points, for example). A default pointassignment scheme may be presented for approval by a health careprovider. The health care provider may then adjust the point assignmentscheme to fit the needs of an individual patient 2104.

In operation 2702, the point value of each of the questions actuallyasked to the patient 2104 is determined. Thus, questions that were notasked to a patient 2104 are not included in this point total. Inoperation 2704, the patient's 2104 earned point value is totaled. Then,in operation 2706, the patient's 2104 earned point total (determined inoperation 2704) is divided by the total possible point value (determinedin operation 2702).

In operation 2708, it is determined whether the fraction found inoperation 2706 exceeds a threshold (as with the point assignment scheme,the threshold may be defined by the health care provider). If so, thepatient's health care provider is notified (perhaps by the issuance ofan exception report), as shown in operation 2710. Finally, the processterminates in operation 2712.

FIG. 28 depicts another method by which the patient's 2104 answers tothe questions presented in the hierarchies 2200 may be analyzed.According to the method depicted in FIG. 28, during operation 2800 apoint value is assigned to each question in each of the invoked questionhierarchies 2200. The details of the point assignment scheme areidentical to those in operation 2700 of FIG. 27.

Next, in operation 2802, a threshold is assigned to each invokedhierarchy 2200. Again, this threshold may be assigned by default, andthe health care provider may be given an option to adjust thisthreshold. The threshold of operation 2802 applies to each hierarchy2200, meaning that a decision will be made, on a hierarchy-by-hierarchybasis, whether the patient 2104 has accummulated sufficient points in aparticular hierarchy to cross a threshold assigned to that hierarchy2200. In operation 2804, a second threshold is assigned. The thresold ofoperation 2804 relates to the number of hierarchies 2200 that may beallowed to exceed the threshold of operation 2802.

In operation 2806, the number of points earned by the patient 2104 ineach hierarchy 2200 is determined. Then in operation 2808, it isdetermined whether the number of hierarchies 2200 in which the thresholdof operation 2802 was crossed exceeds the threshold of operation 2804.If so, the patient's health care provider is notified, as shown inoperation 2810. Finally, the process terminates in operation 2812.

The methods of FIGS. 27 and 28 are preferably performed by the remotecomputer 2100, although they may be performed by any other processingdevice. The aforementioned methods are preferably embodied as softwarestored in a memory device within the central computer 2100. However,they may be embodied on a computer-readable medium, such as a compactdisc, a floppy disc, a network cable, or any other form of mediareadable by a computer.

Thus, it will be appreciated that the previously described versions ofthe invention provide many advantages, including addressing the needs inthe medical profession for an apparatus and method capable of monitoringand transmitting physiological and/or wellness parameters of ambulatorypatients to a remote site whereby a medical professional caregiver canevaluate such physiological and wellness parameters and make decisionsregarding the patient's treatment.

Also, it will be appreciated that the previously described versions ofinvention provide other advantages, including addressing the need for anapparatus for monitoring and transmitting such physiological and/orwellness parameters that is available in an easy to use portableintegrated single unit.

Also, it will be appreciated that the previously described versions ofthe invention provide still other advantages, including addressing theneed for medical professional caregivers to monitor and manage thepatient's condition to prevent the rehospitalization of the patient, andto prevent the patient's condition from deteriorating to the point wherehospitalization may be required.

Although the invention has been described in considerable detail withreference to certain preferred versions thereof, other versions arepossible. For example a weight management and control apparatus.

Therefore, the spirit and scope of the appended claims should not belimited to the description of the preferred versions contained herein.

1. A health care device for monitoring a health condition of anambulatory patient, the device comprising: a display for presentingquestions to the patient; an input device permitting the patient toenter answers to the questions; a read-only memory device, the read-onlymemory device storing a plurality of question hierarchies, eachhierarchy of questions corresponding to each of a plurality of symptoms;a communication device; a microprocessor is programmed to receive asymptom identifier via the communication device; based upon the symptomidentifier, ask a first question from the hierarchy of questionscorresponding to the symptom identified by the symptom identifier;receive an answer to the first question via the input device; and basedupon the answer to the first question, make a decision regarding whetherto ask a subsequent question from the hierarchy. 2-39. (canceled)